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Dealing with Medicare and Medicaid Overpayments : Medicare and Medicaid overpayments are pretty common. If they are not dealt with properly, they invite penalties. Medicare and Medicaid Overpayments happen when a person, provider or supplier receives a payment that is in excess of the amount due to him or her under Medicare statutes and regulations. This overpayment becomes a federal debt that is owed by the individual to the State. So, Centers for Medicare and Medicaid Services (CMS) is required by federal law to recover this amount. Overpayments routinely occur in Medicare and Medicaid. Many a time, these are unintended and are usually a result of oversight, but could also happen due to intent. Some of the most common reasons for which Medicare and Medicaid overpayments occur can be when: Duplicate submissions of the same service or claim are made Excessive or non-covered services are billed or furnished for billing Services that are not necessary medically or are excluded are paid for The wrong payee gets paid. How are Medicare and Medicaid overpayments processed? Obamacare has amended the federal False Claims Act (FCA), which is part of the Fraud Enforcement Recovery Act of 2009 (FERA), to add provisions relating to recovery of Medicare and Medicaid overpayments. This is how the process of Medicare and Medicaid overpayments works: Whenever Medicare comes to know that any overpayment of $10 (raised to $25 from July 2014) or more is made, it directs the Medicare Administrative Contractor (MAC) to initiate the process of recovery of this overpayment. The MAC starts the process by initially mailing a demand letter in which repayment is requested If no action is taken, a second and third demand letters are mailed in a month following the first one. Contents of a demand mail from Medicare/Medicaid: The demand letter sent by the MAC will explain the details of the Medicare and/or overpayment. When repayment is not made in full within 30 days, interest starts get

The process of credentialing safeguards patients' safety with an accreditation hat a physician is well-qualified to perform his duties. How this process goes and what laws should be there to protect the process.

The process of credentialing safeguards patients' safety with an accreditation hat a physician is well-qualified to perform his duties. How this process goes and what laws should be there to protect the process

The process of sterilization and disinfection has always been crucial in maintaining optimum hygiene in any given setting. However, the ongoing COVID-19 pandemic has heightened the importance of these processes. Sterilization refers to any process that removes, eradicates, or kills all forms of life particularly, fungi, bacteria, viruses, spores, etc. Sterilization equipment and disinfectants are crucial in modern medical care as patients come in contact with syringes, surgical tools, and bandages all time. These medical devices eliminate any foreign particles, pus, blood, and dirt left behind that could create complications for the next patient requiring surgery. Besides, it decreases bioburden and prevents corrosion of expensive and highly precise tools. There are different sterilization processes performed including steam sterilizing, flash sterilizing, low-temperature sterilizing, hydrogen peroxide gas plasma, ethylene oxide gas sterilization, peracetic acid sterilization, etc. Many regulatory authorities have issued guidelines on how to sterilize medical equipment. The hospitals refer to it as a germ warfare strategy and it is done in a specific order. The first step is cleaning followed by disinfection which involves using liquid chemicals to kill non-spore-forming bacteria. The final step is sterilizing where several methods are employed to kill disease-causing microorganisms and also eradicate transmissible agents such as spores and bacteria. Read more @ https://coherentmarketinsights-cmi.blogspot.com/2020/12/sterilization-equipment-and.html

In order to become a safe and effective medicine, a compound has to travel through a lengthy process of rigorous testing. Over the last few decades, the amount of time required to develop and test a novel drug has increased drastically. However, the introduction of social media and digital technology into drug development have the ability to significantly expedite this process. This webinar will explore the policies and principles of using social media through the evolution of developing a pharmaceutical drug from its initial stages to its introduction into the market. This includes analyzing the methods in which pharmaceutical companies utilize social media during the planning process, identifying the best candidate for the lead compound in a drug, conducting animal and human testing, recruiting candidates for clinical trials.

Overview: One of the major requirements of the health care organization to be HIPAA compliant is to develop and implement a set of HIPAA privacy and security policies and procedures. This can be a daunting task for those not knowing where to start and what a set of HIPAA privacy and security policies and procedures should look like. For the cost conscious health care organization, the HIPAA policies and procedures can have multiple uses: first, they can become a basis for training the health care organization workforce; second, they can be used as a basis for conducting a HIPAA self-assessment; and third, they can be used to demonstrate due diligence should there be a breach or an externalHIPAA compliance audit. In today's world it is not necessary that the health care organization spend significant funds to develop a set of HIPAA privacy and security policies and procedures from scratch. The health care organization can likely find templates on the internet that can be used as a starting point to customize HIPAA policies and procedures to be unique for the health care organization. The preparation of a well-documented set of HIPAA policies and procedures needs to be addressed through the development of Privacy and Security policies and procedures that address each of the requirements shown in the HIPAA regulations as amended by the HITECH law and the final Omnibus Regulations. The process of developing the HIPAA privacy and security policies and procedures also provides a reference for the health care organization how to consider the security addressable and required regulation requirements. Why should you attend: There are three situations where having a set of HIPAA policies and procedures are needed: First, the policies and procedures become a good reference to ensure that all areas are addressed for becoming HIPAA compliant. Second, the HIPAA regulations REQUIRE covered entities and business associates to have a set of policies and procedures directing

Overview: New changes modifying the HIPAA Privacy and Security Regulations are going into place to meet the privacy and security mandates within the HITECH Act in the American Recovery and Reinvestment Act of 2009. The changes include establishing new rights for individuals as well as changes to the limitations on uses and disclosures. New requirements for patient access to records and requirements to notify individuals in the event of a breach are only two of the many areas affected in the new law, including new requirements for restriction and accounting of disclosures and increased enforcement activity. Covered entities that use electronic health records (EHRs) will need to meet new access and disclosure rules and all kinds of business associates and their subcontractors will need to establish compliance programs. And if you are required to have a HIPAA Notice of Privacy Practices, you will need to update that to show all the new rights that patients will have, such as electronic copies, new rights to restrict disclosures, and much more. Business associates are now directly covered by the HIPAA privacy and security regulations and are liable for fines and penalties if they do not comply. If a business associate supplies services that interact with the new changes to the rules, the BA will need to be aware of the new requirements. We will explain what a Business Associate needs to do differently under the new regulations. Electronic records have new demands placed on them, in both providing access and in accounting for all disclosures of health information - the electronic age in health care brings new obligations to serve individuals as well as manage health information for healthcare professionals. We will discuss how disclosures must be tracked in an EHR and review the various ways patient records can be supplied electronically. The new regulations will be reviewed and their effects on usual practices will be discussed, as will what policies need to be chang

A Hospital Incident Command System is a wonderfully effective system for handing disasters and emergency situations: A Hospital Incident Command System is an absolute must for hospitals when they have to carry out unforeseen emergencies. Having a process-oriented Hospital Incident Command System is an effective tool for dealing with situations and saving lives. A Hospital Incident Command System (HICS) is a standardized process that helps hospitals deal with emergencies, natural or manmade. HICS is common across hospitals in the US and have common terminology and organizational structure. It is a single system that all hospitals have to use. Since emergencies can happen at any time and can be of any gravity; it is imperative for physicians to have a command of how to deal with emergencies by understanding the Hospital Incident Command System and its role in disaster situations. HICS goes beyond patient care. Physicians and other staff need to both have access to disaster-specific and related information to the Hospital Incident Command System, as well as know how to handle it, in order to bring about an effective response and augment an existing one. Advantage of having a Hospital Incident Command System The biggest advantage of having a Hospital Incident Command System is that its practices and processes are similar to those used by external agencies in times of emergency. This makes sharing incident command systems that much more effective and easier to coordinate, and facilitates information flow. Features of a Hospital Incident Command System A Hospital Incident Command System provides a flexible reporting structure with defined roles and responsibilities It sets up and facilitates communication flow and documentation protocol It provides the hospital operations a concrete strategic direction-oriented support by leveraging and optimizing additional resources such as staff and equipment, so that these are used where they are needed the most. A Hospital Incident

Overview: Health care practitioners and other licensed professionals work in today's diverse, fast-changing, multidisciplinary environment. All licensed professions have higher rates of drug abuse, alcohol abuse, and mental health issues. Yet each individual profession has a unique, though similar, state laws which govern how state licensing agencies take action against the professional so as to protect the public. The state's authority and power over licensed professionals often presents challenges to the impaired practitioner that are not easy to navigate. All licensed professionals must adhere to standards of state law which govern their professional practices and include prohibitions for impaired practice - even impairment along that is apart from any direct professional harm. Complaints that are received and investigated by a state agency leave the licensed professional with an uncertain process to handle the state action against them. Coupled with numerous related consequences, such as loss of employment, family issues and divorce, and criminal actions, the licensed professional must handle all these challenges successfully. Learn to identify and understand varying state laws that apply to allow disciplinary action against the licensed professional, both immediately and temporarily, and those which are permanent and final. Review the most common successful elements of the rehabilitation of the licensed professional faced with the deadly consequences of addiction. Compare and contrast regulatory laws and due process requirements for state action. This allows the licensed professional to avoid career-ending sanctions and to defend successfully against legal actions which may result in ruinous practice and career consequences for the professional. This program offers an objective, thorough review of laws which apply to the impaired licensed professional. Why should you attend: Health care practitioners are faced with a higher lifetime risk of drug abuse,

Overview: In this webinar, Hope will present the lessons she's learned over her career as a grant writer and editor in medical research. By identifying simple solutions to common problems, participants will learn tools to improve their ability create competitive grant applications and increase their academic and research productivity. To write compelling grant applications, this webinar will cover: How your choice of words will help you stay within page limits without compromising the science How to minimize abbreviations to improve readability and respect reviewer time constraints How to use Microsoft Word efficiently to improve page layout and readability How to manage references by enlisting online databases and reference management software How and when to stop developing the content to meet both grantor and institutional deadlines Why should you Attend: Many Grant Writing workshops do not teach writing per se. Though useful for beginning grant writers, most focus on understanding the application process and the various sections of a grant. For participants wanting to learn to actually write a grant, they are often left to figure out the technique for themselves. In addition, funding opportunity applications (FOAs) have changed quite rapidly in the past few years and require more focused writing in fewer pages. Competition has increased as budgets have shrunk, and knowing how to make the most out of both the time and the length of a grant project can prove challenging and extremely stressful. This webinar is for both new and experienced grant writers, either scientists and principal investigators or writers and other support staff. By using common resources (MS Word, EndNote, PubMed), the webinar content is designed to help grant-writing teams increase their efficiency in the writing process and also meet the requirements of the FOAs. Plus, plain language and good writing practices taught in this webinar will ensure straight-forward, content-rich, and well

Overview: One of the major requirements of the health care organization to be HIPAA compliant is to develop and implement a set of HIPAA privacy and security policies and procedures. This can be a daunting task for those not knowing where to start and what a set of HIPAA privacy and security policies and procedures should look like. For the cost conscious health care organization, the HIPAA policies and procedures can have multiple uses: first, they can become a basis for training the health care organization workforce; second, they can be used as a basis for conducting a HIPAA self-assessment; and third, they can be used to demonstrate due diligence should there be a breach or an externalHIPAA compliance audit. In today's world it is not necessary that the health care organization spend significant funds to develop a set of HIPAA privacy and security policies and procedures from scratch. The health care organization can likely find templates on the internet that can be used as a starting point to customize HIPAA policies and procedures to be unique for the health care organization. The preparation of a well-documented set of HIPAA policies and procedures needs to be addressed through the development of Privacy and Security policies and procedures that address each of the requirements shown in the HIPAA regulations as amended by the HITECH law and the final Omnibus Regulations. The process of developing the HIPAA privacy and security policies and procedures also provides a reference for the health care organization how to consider the security addressable and required regulation requirements. Why should you attend: There are three situations where having a set of HIPAA policies and procedures are needed: First, the policies and procedures become a good reference to ensure that all areas are addressed for becoming HIPAA compliant. Second, the HIPAA regulations REQUIRE covered entities and business associates to have a set of policies and procedures directing t

Stem cell banking is the process of collecting, processing, and storing potentially life-saving stem cells for future use. Stem cells have the potential to recreate and preserve the body, with their ability to develop into many different types of blood and tissue cell. Stem cell therapies can be used to treat diseases and repair organs and damaged tissues. Currently, cord blood stem cells can be used in transplants and therapies to treat more than 85 diseases, such as anemia, lymphomas, bone marrow cancer, and leukemia. With stem cell banking services gaining traction, adult stem cell preservation has been one of the fastest-growing areas of stem cell research. Stem cell preservation is the process of preserving stem cells that can be used for future treatments. The demand for stem cell preservation is increasing every day and is a wise investment for future medical needs. Moreover, stem cells can be used for the treatment of several life-threatening diseases, such as cancer, diabetes, and other chronic conditions. Stem cell banking offers the hope of turning these negatives into positives and helping stem cells to be effective and successful for future use. Read more @ https://coherentmarketinsights-cmi.blogspot.com/2020/12/banking-stem-cells-is-good-idea-as-they.html

Navigating the healthcare credentialing process and making use of medical credentialing services are vital steps for healthcare vendors. Instapay Healthcare Services emerges as a reliable preference, providing efficiency, know-how, and a commitment to excellence. By information the intricacies of credentialing and making knowledgeable picks, healthcare carriers can prioritize affected person care even as ensuring they meet all essential requirements.

Overview: The primary goal of this session is to demonstrate why the health care organization needs to perform a risk assessment and how to perform the risk assessment. This includes a description of the types of breaches of protected health information that have already occurred and the reasons those breaches happened. The presentation then provides that reasons that a risk assessment is required in a health care organization and who needs to perform the assessment. There are a number of approaches available both for purchase on the web and performed by professionals on site. This discussion helps the participant determine which approach is best for their health care organization and what portions of the assessment are most important to the organization. The topic addresses the key components of a risk assessment and how to perform the risk assessment. This includes how to define the specific risks, how to know, how to assess the likelihood and impact of the risk and the final determination on the level of severity of the risk for the organization. Finally, the session explains how to interpret the results of the risk assessment, how to use the results of the risk assessment for preparing the health care organization's policies and procedures and how to conduct the HIPAA training for its staff. Why should you attend: In addition to the negative publicity and potential fines, a breach of a patient's health information often leads to litigation which is also time consuming and costly. The way to avoid these situations is to perform a Risk Assessment to understand where the health care organization is risk of an unauthorized breach and provide a basis for becoming HIPAA compliant. There are three reasons why a Risk Assessment is necessary: First, both the HIPAA Privacy and Security Regulations require a Risk Assessment for the organization to be HIPAA compliant Second, as a result of the Risk Assessment the organization knows where it needs to address its effo

The emerging discipline of Hospitals Management Performance Assessments Over the past few years, Hospitals Management Performance Assessments have begun to gain acceptability and credence in healthcare circles. Hospitals Management Performance Assessments came into being as a result of a conscious effort by advanced countries, mainly European, with sufficient backing from the World Health Organization (WHO) to arrive at some sort of metrics to evaluate the critical functioning levels of hospitals. The topic of Hospitals Management Performance Assessments came to acquire proper shape and structure following the heavy reference the WHO made to this discipline at the WHO European Ministerial Conference on Health Systems of June 2008. The following year, it found resonance again, when it was the theme of the World Health Day. The evaluation of Hospitals Management Performance Assessments Hospitals Management Performance Assessments started to evolve primarily to provide healthcare professionals with a tool to diagnose the quality of performance of the hospitals and other healthcare settings they work in. It was felt, over time and experience, that when strict appraisals were being made in many areas of healthcare, a set of parameters to assess the level of efficiency of hospitals would go a long way in ensuring the implementation of enhanced processes, leading to better patient outcomes. Areas of concentration for Hospitals Management Performance Assessments The core disciplines in which Hospitals Management Performance Assessments sought to bring about measurable and verifiable improvements were: The PATH approach As a result of discussions and deliberations the WHO held with many countries, primarily European, a path for charting out the course of Hospitals Management Performance Assessments was concretized in the form of what the WHO called the PATH - the Performance Assessment Tool for Quality Improvement in Hospitals. A brief understanding of PATH PATH

Clinical Risk Management Lies at the Heart of Patient Safety : Clinical Risk Management is the process of identifying and mitigating risks in a healthcare setting. Risks are inherent in a clinical or healthcare practice, as they are in any other activity. But the field of healthcare has to be doubly wary of risk management because an adverse risk can cause irreparable loss if it leads to an event such as death. To a healthcare organization or practice, a bad event can harm the name beyond repair. How is risk identified? The first step to implementing a Clinical Risk Management is identifying the risks in the practice. This can be done in a number of ways: Why do healthcare providers need to implement a Clinical Risk Management strategy? Healthcare providers need to put in place a very sound Clinical Risk Management strategy for a number of reasons: Steps to putting a good Clinical Risk Management program in place A healthcare organization can put an effective Clinical Risk Management in place through a four-step process: Click Here for More Information: http://bit.ly/1OcHFXm

Course "The A to Z's of HIPAA Privacy, Security, and Breach Notification Rules" has been pre-approved by RAPS as eligible for up to 12 credits towards a participant's RAC recertification upon full completion. Overview: This session is designed to provide intensive, two-day training in HIPAA compliance, including what's new in the regulations, what's changed recently, and what needs to be addressed for compliance by covered entities and business associates. The session provides the background and details for any manager of healthcare information privacy and security to know what are the most important privacy and security issues, what needs to be done for HIPAA compliance, and what can happen when compliance is not adequate. Audits and enforcement will be explained, as well as privacy and security breaches and how to prevent them. Numerous references and sample documents will be provided. Who Will Benefit: * Information Security Officers * Risk Managers * Compliance Officers * Privacy Officers * Health Information Managers * Information Technology Managers * Medical Office Managers * Chief Financial Officers * Systems Managers * Legal Counsel * Operations Directors Agenda: Day One Day one sets the stage with an overview of the HIPAA regulations and then continues with presentation of the specifics of the Privacy Rule, recent changes to the rules, and the basics of the Security Rule Lecture 1: Overview of HIPAA Regulations * The Origins and Purposes of HIPAA * Privacy Rule History and Objectives * Security Rule History and Objectives * Breach Notification Requirements, Benefits, and Results Lecture 2: HIPAA Privacy Rule Principles, Policies and Procedures * Patient Rights under HIPAA * Limitations on Uses and Disclosures * Required Policies and Procedures * Training and Documentation Requirements Lecture 3: Recent and Proposed Changes to the HIPAA Rules * New Penalty Structure * New HIPAA Audit Program * New Patient Rights

Course "Texting and E-mail with Patients: Patient Requests and Complying with HIPAA " has been pre-approved by RAPS as eligible for up to 12 credits towards a participant's RAC recertification upon full completion. Overview: With the recent advances in portable technology, more and more organizations and their users are taking advantage of mobile devices to save time and get work done more efficiently. Texting, portable e-mail, and Apps are revolutionizing the ways health care providers interact with their patients and get their work done. But the use of these devices comes with hidden costs of compliance, especially if they lead to a reportable breach under HIPAA or state laws. HIPAA Privacy and Security Officers have been struggling to keep up with the use of the devices to protect patient privacy and avoid compliance issues. Even if these devices aren't in formal use in your organization, you need to act now to anticipate their use and make sure they are used properly. This session is designed to provide intensive, two-day training in HIPAA compliance as it relates to the use of mobile devices, including how to use them with Protected Health Information, the policies and procedures you need to have in place to use them securely, and how to manage issues of the "BYOD" phenomenon. The session provides the background and details for any manager of health information privacy and security to know what issues to look for with mobile devices, what needs to be done for HIPAA compliance, and what can happen when compliance is not adequate. Audits and enforcement will be explained, as well as privacy and security breaches and how to prevent them. Numerous references and sample documents will be provided. The session will be valuable for both newcomers to HIPAA compliance as well as seasoned veterans. HIPAA compliance will be explained and discussed in detail, from the basics through the latest changes and new technology issues, so that the attendee will have a coherent u

Elements of an efficient Healthcare computer system implementation Healthcare computer system implementation lies at the heart of a healthcare delivery information system. The processing and dissemination of information in extremely quick time is indispensable to healthcare, given the number of processes that go into the healthcare information system, and the improvement in care this can bring about. A healthcare computer system, which can be described as the ecosystem of a healthcare delivery information system, is thus a critical component, because this healthcare computer system implementation is what decides between the efficiency of a healthcare information system and lack of it. A healthcare computer system implementation should cover all the core areas that are part of a healthcare delivery information system, such as the patient, the caregiver, the medical records concerning the patient, the healthcare organization, and other aspects of administration, such as admission, billing and so on. What goes into an efficient healthcare computer system implementation? An efficient healthcare computer system implementation consists of taking into account all the major elements of a healthcare delivery information system. It should have the ability to synchronize, coordinate and integrate vital data from across departments and systems. An efficient healthcare computer system implementation should also take into account the technologies that go into them. Technologies keep changing rapidly. New ones come into being and render the old ones obsolete in no time. A healthcare computer system implementation has to take into account the nature of these changes, and should implement them in quick time. Technologies and technological tools that are doing the rounds today include the cloud, mobile technologies and the social media. So, a healthcare computer system implementation has to integrate these. In the particular context of the American healthcare system, healthca

Overview: Many medical entities are increasingly struggling to manage revenue effectively. Self pay is on the rise due to high deductibles. Bad debt is increasing. What is your plan to manage these areas? Staff trained in denial management? Variances? Are they handling these areas in a timely manner? Payers have time limits in which dollars can be salvaged. Missing those strategic times mean dollars lost. Don't leave money on the table. We will discuss multiple avenues in which strong training and timely action can equal $$$. Why should you Attend: Don't lose hard earned revenue. Learn tips to strategic follow up, when and how to manage the appeal process. Is the claim appealable? Partial payments and why? Today's industry of high dollar deductibles create the necessity to expend additional efforts on self-pay accounts. There is a significant difference in collecting small co-pays and managing large balances. Bad debt creep? What is your plan for managing these areas? Areas Covered in the Session: Hire the right staff - Then engage in ongoing education Variances and denial management Billing compliance Coding for specificity, co-existing conditions and correct modifiers Supporting medical necessity CCI edits and unbundling Productivity Claims follow up Payer processing edits Additional development requests Handling problem claims and appeals Who Will Benefit: Coders Billers Revenue cycle Physicians, mid-level providers Nurses Claims follow-up Managers Speaker Profile Dorothy D. Steed is an Independent Healthcare Consultant and Educator in Atlanta. She was a Medicare specialist for a large hospital system and a physician coding audit supervisor for another hospital system, with 38 years of experience in healthcare. Additionally, she is an instructor at a state technical college in Atlanta, provides auditing & training in both facility and physician services, and has been a speaker at several healthcare conferences. Ms. Steed has written articles for

Overview: With the recent advances in portable technology, more and more organizations and their users are taking advantage of mobile devices to save time and get work done more efficiently. Texting, portable e-mail, and Apps are revolutionizing the ways health care providers interact with their patients and get their work done. But the use of these devices comes with hidden costs of compliance, especially if they lead to a reportable breach under HIPAA or state laws. HIPAA Privacy and Security Officers have been struggling to keep up with the use of the devices to protect patient privacy and avoid compliance issues. Even if these devices aren't in formal use in your organization, you need to act now to anticipate their use and make sure they are used properly. This session is designed to provide intensive, two-day training in HIPAA compliance as it relates to the use of mobile devices, including how to use them with Protected Health Information, the policies and procedures you need to have in place to use them securely, and how to manage issues of the "BYOD" phenomenon. The session provides the background and details for any manager of health information privacy and security to know what issues to look for with mobile devices, what needs to be done for HIPAA compliance, and what can happen when compliance is not adequate. Audits and enforcement will be explained, as well as privacy and security breaches and how to prevent them. Numerous references and sample documents will be provided. The session will be valuable for both newcomers to HIPAA compliance as well as seasoned veterans. HIPAA compliance will be explained and discussed in detail, from the basics through the latest changes and new technology issues, so that the attendee will have a coherent understanding of not only the rules, but also how to think about compliance and make sound compliance decisions on a day-to-day basis in the context of mobile devices. Agenda Day One Day one sets the stage with an ov